Are the Hub and on the same Wheel€¦ · Outline of presentation ... • AAMD workforce study...
Transcript of Are the Hub and on the same Wheel€¦ · Outline of presentation ... • AAMD workforce study...
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Are the Hub and Spokes on the same Wheel
Chester S. ReftDepartment of Radiation & Cellular OncologyUniversity of Chicago
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The REPRC criteria for accreditation
Residency Education Program Review Committee Adapted from REPRC guidelines written by Bruce
Gerbi & Peter Dunscombe
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Guidelines for Accreditation of Residency Programs
Affiliated Sites Appendix 1.
AAPM websitewww.campep.org
Under Residency Education Programs
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Outline of presentation
• Background information & statistics on manpower•CAMPEP – purpose and policies
•Recent changes in policies• Hub & Spokes residency
• Hub & Spokes – similarities /differences•Key points•Questions
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Sources and Initiatives for US Staffing Recommendations in Radiation
Oncology• ASTRO – safety is no accident• ASTRO – ACR database• ABT III report• Battista model ‐ Canadian workforce study
• AAMD workforce study
(Statistics on manpower provided by Michael Mills)
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What does the ASTRO – ACR Database and Abt Report Reveal?
• Practice venue largely does not matter• Community based centers, Freestanding centers and University centers require similar staffing
• The only variable that affects staffing is the number of patients treated in the facility on an annual basis
• Statistically, the fewer the number of patients treated annually in a center, the more generous is the staffing
• In the ASTRO‐ACR database, staffing numbers are reported for facilities treating > 600, 200‐600 and < 200 patients annually
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How many patients annually per Qualified Medical Physicist
• Abt I 1995 421• Abt II 2003 325• Abt III 2008 304
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Median overall staffing information in 2007
# Patients treated per year 595
# Qualified Medical Physicists 2.0
# Radiation Oncologists 3.0
# Dosimetrists or Junior Medical Physicists
3.0
# Maintenance Engineers 0.0
# Radiation Therapists 8.0
# Radiation Oncology Nurses 3.0
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When was the big demand?
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THE QUALIFIED MEDICAL PHYSICIST
It is expected that an individual will not hold himself/herself out to be qualified in a subfield for which he/she has not established competency. An individual will be considered competent to practice one or more of the subfields of Medical Physics if that individual is certified in that subfield by any one of the following:
1. The American Board of Radiology2. The American Board of Medical Physics3. The American Board of Health Physics4. The American Board of Science in Nuclear Medicine5. The Canadian College of Physics in Medicine
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The American Association of Physicists in Medicine regards board certification in the appropriate medical subfield and continuing education as the appropriate qualification for the designation of Qualified Medical Physicist.
In addition to the above qualifications, a Qualified Medical Physicist shall meet and uphold the "Guidelines for Ethical Practice for Medical Physicists" as published by the American Association of Physicists in Medicine, and satisfy state licensure where applicable.
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Supply and Demand, QMD versus QMP
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• Comparing the service mix and the work hours of the median QMD and QMP, there is almost an exact overlap of both services and work hours by code
• Staffing of the QMD and QMP also match closely in the Abt study, the Battista study, the IAEA study and the ACR/ASTRO Radiation Oncology Accreditation Program Requirements Guide.
• Supply and demand curves are different for QMDs and QMPs. However, both show that as additional qualifications to take the professional boards are emerging and as the baby boom generation retires, there are anticipated shortages in the supply of both professions toward the end of the decade.
QMDs and QMPs – some thoughts
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• Why is radiation oncology profitable?– The profitability of radiation oncology is largely based off of one,
single procedure – the Medicare IMRT code 77418– In 2003, one fraction of IMRT was judged to equal 1/7th the
reimbursement of a liver transplant and 1/3rd of that of an aortic valve replacement
– One IMRT fraction was placed on par with a rib removal or bunion surgery
– The beauty of IMRT is that while most people have only a finite number of livers, aortic valves, ribs, and bunions, each cancer patient treated with IMRT typically gets 30‐40 treatments
– So a course of IMRT cancer therapy costs the system as much as transplanting 5 livers, and removing 30 bunions
– CMS made an attempt to cut IMRT by ~ 38% in 2009 as a result of a review of broader imaging codes – ASTRO and other groups stopped the cuts
– This year, 2012, CMS is proposing to cut IMRT reimbursement to physician owned freestanding centers by ~ 40%
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Projected ABR TMPs through 2020
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2014 INITIATIVE
To sit for the ABR board examination in 2014 and beyond, applicants must have graduated from a CAMPEP accredited residency
program
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2020–If we graduate 100 TMPs
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2020–If we graduate 150 TMPs
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2020–If we graduate 200 TMPs
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MS Medical Physicists accepted to CAMPEP Residency Programs
• Accepted:– ***************
• Not Accepted– ********************************************************************************************************************************************
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PhD Medical Physicists accepted to CAMPEP Residency Programs
• Accepted
• *********************************************
• Not Accepted
• ********************
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• Designed by Michael Mills and Ed Nickoloff• Created October 12, 2011• Survey opened on November 8 2012• Closed survey on February 27, 2012 with 460 responses
• Purpose was to measure medical physicist staffing and workload by type of equipment
• Purpose was also to assign a medical physicist cost per patient procedure for each type of equipment
Diagnostic Workforce Study
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Diagnostic Workforce Summary• We expected to see larger differences between physicists
working in academic centers and those serving community hospitals
• Most medical physicists providing imaging and nuclear medicine services are about 50% clinical
• Other duties are administration, teaching and research• There are a few (about 10% of the total reporting) highly
productive full time consulting medical physicists who are 100 percent clinical and demonstrate about twice the median productivity
• These individuals do not impact the median numbers reported
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Summary and Conclusions• Radiation oncology is not profitable because of physics
procedures – these do well to break even• Radiation oncology profits depend almost entirely on
77418 – IMRT treatment delivery; this code is under attack• If radiation oncology fails to remain profitable, all the
supply and demand models and all the workforce assessments may be meaningless because no one will want to provide the services
• It is not ethical for highly successful MS students to be denied the opportunity to take the ABR Certification examinations because we mismanaged the educational process
• We must make residency opportunities available for our MS students now
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CAMPEPCommission on Accreditation of
Medical Physics Educational Programs
It is a nonprofit organization whose objectives are the review and
accreditation of educational program in medical physics
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CAMPEP
Mission – to promote consistent quality education of medical physicists by evaluating & accrediting Graduate, Residency and Continuing Educational programs that meet high standards established by CAMPEP in collaboration with its sponsoring organizations
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Sponsoring Organizations
AAPMCOMPACRRSNAASTRO
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ACCREDITATION
• Initial accreditation – for 5 years expiring 31 Dec. of fifth year
• Provisional – accreditation limited to less than 5 years & may be extended to 5 years pending interim report
• Deferred – programs requiring additional time to be compliant
• Withheld – non‐compliant with CAMPEP standards and appears changes could not be achieved within reasonable time period
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Recent Residency Guideline Changes
• Residency program directors will be responsible to ensure residents meet all didactic requirements
• As of 1 July 2013 there will be a requirement for Ethics and Professional training
• No financial requirement that the resident receive remuneration at the level of the medical resident
• CAMPEP applied for accreditation with the Council for Higher Education Accreditation (CHEA)
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CAMPEP policies to satisfy CHEA
Posted on programs website:• # students applying per year• # students accepted per year• # students graduating per year• # students certified per year• Student activity post residency• No names or individual information
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Pathways to Residencies
• Graduate from CAMPEP accredited graduate program – MS or Ph.D
• CAMPEP accredited certificate – PhD physics or closely related field
• DMP – MS + 2 year residency
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Graduate level core topicsReport 197S www.aapm.org/pubs/reports/RPT 197S.pdf
1. Radiological Physics and Dosimetry2. Radiation Protection and Radiation
Safety3. Fundamentals of Imaging in Medicine4. Radiobiology5. Anatomy and Physiology6. Radiation Therapy Physics
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Summary of Residency Programs
Programs Accredited In Process
Therapy 60 9
Diagnostic 6 3
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Nuclear Medicine Residencies???
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Residency Education Program Review Committee (REPRC)
Assign review team (1 2 mo)Evaluate self‐study (1 2 mo)Institution response to evaluation (12 mo)Schedule site visit (1 4 mo ???)Review team submits report to REPRC for discussion/vote (≈ 1 mo)
REPRC sends recommendation to CAMPEP BOD
714 days discussion + 7 days vote
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28 “volunteer” reviewers
Patience in Review Process
Reminder
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POLICY
Medical Physics Residency Education Programs encompassing affiliate sites (spokes) shall ensure that uniform
standards and procedures are maintained across all participating institutions.
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Accreditation Applications for Hub & Spokes Programs include
1. Official letter from PD institution confirming participation of named affiliates (spokes)
2. Diagram describing the organizational structure & clear accountability lines
3. Official letters from all affiliate sites requesting CAMPEP accreditation
4. Letters of agreement between the affiliate sites and primary site describing liability, responsibility, accountability and any financial arrangements
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Specific Concerns
1. Self‐study explicitly address communication within the program• frequency• format – videoconference etc.• membership at program meetings
2. Detailed rotation schedule –identify mentors at affiliated sites
3. If spoke affiliate send residents to sub‐spokes within their systemmust identify mentor at each location
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Letter from the Associate PD at each affiliate must confirm
1. Program completion consistent with Program self‐study
2. Resident remedial activities (didactic/clinical) consistent with self‐study
3. All documentation including evaluations of and by the resident across all sites consistent with the self‐study
4. PD is acknowledged as having ultimate responsibility for accreditation of the program
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Procedure
•The primary Program site the one employing the PD•Spoke site under separate governance & budget•All correspondence between CAMPEP through PD•PD has ultimate responsibility for program compliance•Affiliate spokes must appoint Associate PD to insure
compliance•All records related to operation of the program must be
available at all sites
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Program Review of Spoke Affiliates
1. One member from the main hub2. Second member from either the hub or spoke
affiliate3. At least once a year4. Ensure meeting expectations of the hub
• appropriate records maintained• quality of the education
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New affiliate/spoke sites added to an accredited program?
• New site provide CAMPEP with a self study to be reviewed by CAMPEP
• The site must have all the associated structure & documentation previously described
• May require a site visit• Additional fees will be assessed by CAMPEP for conducting the site review
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Key Points to Remember
•Single body with clear line of responsibility•Single faculty albeit with different affiliations•Residents communicate regularly with each other
meetings or tele /video•Elected resident to sit on the residency committee•Standardized evaluation mechanism•Written contractual agreement among components•Director at the Hub is responsible for the entire program
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Thank you for your attention
Questions ???